Evidence-based treatments for borderline personality disorder: Implementation, integration, and stepped care

Harvard Review of Psychiatry

Volumn 24, Issue 5, 2016, Pages 342-356

  Choi Kain, Lois W ^a,b   Albert, Elizabeth B ^b   Gunderson, John G ^a,b  

^a HARVARD MEDICAL SCHOOL   (United States)

^b MCLEAN HOSPITAL   (United States)

Author keywords

Borderline personality disorder; Dialectical behavioral therapy; General Psychiatric Management; Mentalization based treatment; Transference focused psychotherapy

Indexed keywords

ARTICLE; BEHAVIOR THERAPY; BORDERLINE STATE; DIALECTICAL BEHAVIORAL THERAPY; GENERAL PSYCHIATRIC MANAGEMENT; HUMAN; MENTALIZATION BASED TREATMENT; PRIORITY JOURNAL; PSYCHOTHERAPY; TRANSFERENCE FOCUSED PSYCHOTHERAPY; EVIDENCE BASED MEDICINE; PROCEDURES;

BORDERLINE PERSONALITY DISORDER; EVIDENCE-BASED MEDICINE; HUMANS; PSYCHOTHERAPY;

EID: 85018566990     PISSN: 10673229     EISSN: 14657309     Source Type: Journal    
DOI: 10.1097/HRP.0000000000000113     Document Type: Article

References (90)

1. Stern A. Psychoanalytic investigation of and therapy in the border line group of neuroses. Psychoanal Q 1938;7: 467-89.
2. Torgersen S. Epidemiology. In:Wideger T, ed. The Oxford handbook of personality disorders. New York: Oxford University Press, 2012;186-205.
3. Trull TJ, Jahng S, Tomko RL, Wood PK, Sher KJ. Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. J Pers Disord 2010;24:412-26.
4. Gunderson JG, Stout RL, McGlashan TH, et al. Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders Study. Arch Gen Psychiatry 2011;68:827-37.
5. Zanarini MC, Jacoby RJ, Frankenburg FR, Reich DB, Fitzmaurice G. The 10-year course of Social Security disability income reported by patients with borderline personality disorder and Axis II comparison subjects. J Pers Disord 2009;23: 346-56.
6. American Psychiatric Association. Practice guideline for the treatment of patients with borderline personality disorder. Washington, DC: APA, 2001.
7. Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Time to attainment of recovery from borderline personality disorder and stability of recovery: a 10-year prospective follow-up study. Am J Psychiatry 2010;167:663-7.
8. ClinicalTrials.gov. CATIE-Schizophrenia Trial. 2015. https://www.clinicaltrials.gov/ct/show/NCT00014001?order=1
9. ClinicalTrials.gov. Sequenced Treatment Alternatives to Relieve Depression (STAR*D). 2009. https://clinicaltrials.gov/ct2/show/ NCT00021528
10. Ripoll LH, Triebwasser J, Siever LJ. Evidence-based pharmacotherapy for personality disorders. Int J Neuropsychopharmacol 2011;14:1257-88.
11. ClinicalTrials.gov. https://clinicaltrials.gov
12. Silk K. Pharmacology. In: Choi-Kain LW, Gunderson JG, eds. Borderline personality and mood disorders: comorbidity and controversy. New York: Springer, 2015.
13. Stoffers JM, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev 2012;(8): CD005652.
14. Zimmerman M, Mattia JI. Differences between clinical and research practices in diagnosing borderline personality disorder. Am J Psychiatry 1999;156:1570-4.
15. Zimmerman M, Rothschild L, Chelminski I. The prevalence of DSM-IV personality disorders in psychiatric outpatients. Am J Psychiatry 2005;162:1911-8.
16. Paris J. Stepped care: an alternative to routine extended treatment for patients with borderline personality disorder. Psychiatr Serv 2013;64:1035-7.
17. Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF. Evaluating three treatments for borderline personality disorder: a multiwave study. Am J Psychiatry 2007;164:922-8.
18. Bateman A, Fonagy P. Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. Am J Psychiatry 2009;166:1355-64.
19. Jørgensen CR, Freund C, Bøye R, Jordet H, Andersen D, Kjølbye M. Outcome of mentalization-based and supportive psychotherapy in patients with borderline personality disorder: a randomized trial. Acta Psychiatr Scand 2013;127:305-17.
20. McMain SF, Links PS, Gnam WH, et al. A randomized trial of dialectical behavior therapy versus General PsychiatricManagement for borderline personality disorder. AmJ Psychiatry 2009; 166:1365-74.
21. Gunderson JG, Weinberg I, Choi-Kain L. Borderline personality disorder. Focus 2013;2:129-45.
22. Gunderson J, Links P. Handbook of Good Psychiatric Management (GPM) for borderline patients. Washington, DC: American Psychiatric Publishing, 2014.
23. Swenson CR. How can we account for DBT’s widespread popularity? Clin Psychol 2000;7:87-91.
24. Foti ME, Geller J, Guy LS, Gunderson JG, Palmer BA, Smith LM. Borderline personality disorder: considerations for inclusion in the Massachusetts parity list of “biologicallybased” disorders. Psychiatr Q 2011;82:95-112.
25. Linehan M. Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford, 1993.
26. Linehan M. Skills training manual for treating borderline personality disorder. New York: Guilford, 1993.
27. Fonagy P, Bateman A. Psychotherapy for borderline personality disorder: mentalization-based treatment. New York: Oxford University Press, 2004.
28. Bateman A, Fonagy P. Mentalization-based treatment for borderline personality disorder: a practical guide. New York: Oxford University Press, 2006.
29. Clarkin JF, Yeomans FE, Kernberg OF. Psychotherapy for borderline personality. New York: Wiley, 1999.
30. Chanen AM, Thompson K. Borderline personality and mood disorders: risk factors, precursors, and early signs in childhood and youth. In: Choi-Kain LW, Gunderson JG, eds. Borderline personality and mood disorders: comorbidity and controversy. New York: Springer, 2015;155-74.
31. Hegel GWF. The logic of Hegel. Oxford: Clarendon, 1874.
32. Carter GL, Willcox CH, Lewin TJ, Conrad AM, Bendit N. Hunter DBT project: randomized controlled trial of dialectical behaviour therapy in women with borderline personality disorder. Aust N Z J Psychiatry 2010;44:162-73.
33. Koons CR, Robins CJ, Tweed JL, et al. Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behav Ther 2001;32:371-90.
34. Linehan MM, Armstrong HE, Suarez A, Allmon D, Heard HL. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry 1991;48:1060-4.
35. Linehan MM, Tutek DA, Heard HL, Armstrong HE. Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients. Am J Psychiatry 1994;151:1771-5.
36. Turner RM. Naturalistic evaluation of dialectical behavior therapy-oriented treatment for borderline personality disorder. Cogn Behav Pract 2000;7:413-9.
37. van den Bosch LM, Koeter MW, Stijnen T, Verheul R, van den Brink W. Sustained efficacy of dialectical behaviour therapy for borderline personality disorder. Behav Res Ther 2005;43:1231-41.
38. Linehan MM, Comtois KA, Murray AM, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry 2006;63:757-66.
39. Harned MS, Chapman AL, Dexter-Mazza ET, Murray A, Comtois KA, LinehanMM. Treating co-occurring Axis I disorders in recurrently suicidal women with borderline personality disorder: a 2-year randomized trial of dialectical behavior therapy versus community treatment by experts. J Consult Clin Psychol 2008;76:1068-75.
40. McMain S, Guimond T, Cardish R, Streiner D, Links P. Clinical outcomes and functioning post-treatment: a two-year follow-up of dialectical behavior therapy versus General PsychiatricManagement for borderline personality disorder. Am J Psychiatry 2012;169:650-61.
41. Linehan MM. DBT skills training manual. New York: Guilford, 2014.
42. Linehan MM. Dialectical behavior therapy and telephone coaching. Cogn Behav Pract 2011;18:207-8.
43. Carmel A, Fruzzetti AE, Rose ML. Dialectical behavior therapy training to reduce clinical burnout in a public behavioral health system. Community Ment Health J 2014;50: 25-30.
44. Linehan MM, Korslund KE, Harned MS, et al. Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA 2015;72:475-82.
45. Fonagy P. Thinking about thinking: some clinical and theoretical considerations in the treatment of a borderline patient. Int J Psychoanal 1991;72:639-56.
46. Choi-Kain LW, Gunderson JG. Mentalization: ontogeny, assessment, and application in the treatment of borderline personality disorder. Am J Psychiatry 2008;165:1127-35.
47. Fonagy P, Leigh T, Steele M, et al. The relation of attachment status, psychiatric classification, and response to psychotherapy. J Consult Clin Psychol 1996;64:22-31.
48. Fonagy PG, Gergely G, Jurist G, Target EM. Affect regulation, mentalization, and the development of the self. New York: Other, 2002.
49. Agrawal HR, Gunderson J, Holmes BM, Lyons-Ruth K. Attachment studies with borderline patients: a review. Harv Rev Psychiatry 2004;12:94-104.
50. Levy KN, Meehan KB, Weber M, Reynoso J, Clarkin JF. Attachment and borderline personality disorder: implications for psychotherapy. Psychopathology 2005;38:64-74.
51. Choi-Kain LW, Fitzmaurice GM, Zanarini MC, Laverdière O, Gunderson JG. The relationship between self-reported attachment styles, interpersonal dysfunction, and borderline personality disorder. J NervMent Dis 2009;197:816-21.
52. Gunderson JG, Lyons-Ruth K. BPD’s interpersonal hypersensitivity phenotype: a gene-environment-developmental model. J Pers Disord 2008;22:22-41.
53. Bateman AW, Fonagy P. Handbook of mentalizing inmental health practice. Washington, DC: American Psychiatric Publishing, 2012.
54. Bateman A, Fonagy P. Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry 1999;156:1563-9.
55. Gunderson JG. Borderline personality disorder. American Psychiatric Press, 1984.
56. Waldinger RJ, Gunderson JG. Completed psychotherapies with borderline patients. Am J Psychother 1984;38:190-202.
57. Gunderson JG, Prank AF, Ronningstam EF, Wachter S, Lynch VJ, Wolf PJ. Early discontinuance of borderline patients from psychotherapy. J NervMent Dis 1989;177:38-42.
58. Bateman AW, Fonagy P. The development of an attachmentbased treatment program for borderline personality disorder. Bull Menninger Clin 2003;67:187-211.
59. Swenson CR, Choi-Kain LW. Mentalization and dialectical behavior therapy. Am J Psychother 2015;69:199-217.
60. Clarkin JF, Yeomans FE, Kernberg OF. Psychotherapy for borderline personality: focusing on object relations. Washington, DC: American Psychiatric Publishing, 2007.
61. Levy KN, Meehan KB, Kelly KM, et al. Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. J Consult Clin Psychol 2006;74:1027-40.
62. Bernstein J, Zimmerman M, Auchincloss EL. Transference focused psychotherapy training during residency: an aide to learning psychodynamic psychotherapy. Psychodyn Psychiatry 2015;43:201-21.
63. Chambers JE. Discussion of transference-focused psychotherapy training during residency: an aide to learning psychodynamic psychotherapy. Psychodyn Psychiatry 2015;43:223-8.
64. Gunderson JG, Singer MT. Defining borderline patients: an overview. Am J Psychiatry 1975;132:1-10.
65. Gunderson JG, Kolb JE, Austin V. The diagnostic interview for borderline patients. Am J Psychiatry 1981;138:896-903.
66. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: APA, 1980.
67. Wnuk S, McMain S, Links PS, Habinski L, Murray J, Guimond T. Factors related to dropout from treatment in two outpatient treatments for borderline personality disorder. J Pers Disord 2013;27:716-26.
68. Zanarini MC, Frankenburg FR. A preliminary, randomized trial of psychoeducation for women with borderline personality disorder. J Pers Disord 2008;22:284-90.
69. Keuroghlian AS, Palmer BA, Choi-Kain LW, Borba CP, Links PS, Gunderson JG. The effect of attending Good Psychiatric Management (GPM) workshops on attitudes toward patients with borderline personality disorder. J Pers Disord 2016; 30:567-76.
70. Freedman D. Editorial note (especially for the media). Arch Gen Psychiatry 1989;46:983.
71. Gabbard GO. Do all roads lead to Rome? New findings on borderline personality disorder. Am J Psychiatry 2007;164: 853-5.
72. Livesley WJ. Moving beyond specialized therapies for borderline personality disorder: the importance of integrated domainfocused treatment. Psychodyn Psychiatry 2012;40:47-74.
73. DBT-Linehan Board of Certification. Why and how to get certified. 2016. At https://dbt-lbc.org
74. Chanen AM, Berk M, Thompson K. Integrating early intervention for borderline personality disorder and mood disorders. Harv Rev Psychiatry 2016;24:330-41.
75. Hoffman PD, Fruzzetti AE, Buteau E, et al. Family connections: a program for relatives of persons with borderline personality disorder. Fam Process 2005;44:217-25.
76. Asen E, Scholz M. Multi-family therapy: concepts and techniques. London: Routledge, 2010.
77. Asen E, Fonagy P. Mentalization-based family therapy. In: Bateman A, Fonagy P, eds. Handbook of mentalizing in mental health practice. Arlington, VA:American Psychiatric Publishing, 2012;107-28.
78. Livesley WJ, Dimaggio G, Clarkin JF. Integrated treatment for personality disorder: amodular approach. NewYork: Guilford, 2015.
79. Clarkin JF. An integrated approach to psychotherapy techniques for patients with personality disorder. J Pers Disord 2012;26:43-62.
80. Sullivan EEE, A. Strong patient-provider relationships drive healthier outcomes. Harv Bus Rev 2015; 9 Oct.
81. Nuance. Healthcare from the patient perspective: the role of the art of medicine in a digital world. 2015. http://www.nuance.com/ucmprod/groups/healthcare/@web-enus/documents/collateral/nc_031636.pdf
82. Wensing M, Jung HP, Mainz J, Olesen F, Grol R. A systematic review of the literature on patient priorities for general practice care. Part 1: description of the research domain. Soc Sci Med 1998;47:1573-88.
83. Little P, Everitt H, Williamson I, et al. Preferences of patients for patient centred approach to consultation in primary care: observational study. BMJ 2001;322:468-72.
84. Coulter A. The NHS revolution: health care in the market place: what do patients and the public want from primary care? BMJ 2005;331:1199.
85. Hull JW, Yeomans F, Clarkin J, Li C, Goodman G. Factors associated with multiple hospitalizations of patients with borderline personality disorder. Psychiatr Serv 1996;47:638-41.
86. Bender DS, Dolan RT, Skodol AE, et al. Treatment utilization by patients with personality disorders. Am J Psychiatry 2001;158: 295-302.
87. Choi-Kain LW, Gunderson JG. Conclusion: integration and synthesis. In: Choi-Kain LW, Gunderson JG (eds.). Borderline personality and mood disorders. New York: Springer, 2015: 255-70.
88. Zanarini MC. Psychotherapy of borderline personality disorder. Acta Psychiatr Scand 2009;120:373-7.
89. Stanley B, Brodsky B, Nelson JD, Dulit R. Brief dialectical behavior therapy (DBT-B) for suicidal behavior and non-suicidal self injury. Arch Suicide Res 2007;11:337-41.
90. Davidson K, Norrie J, Tyrer P, et al. The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial. J Pers Disord 2006;20:450-65.